Trial begins for doctors blamed in pill mill deaths

Paula McMahon, Sun Sentinel

Two South Florida doctors became "dope dealers" who prescribed massive doses of pain pills — resulting in the overdose deaths of nine people under their care, federal prosecutors said Friday as the physicians' criminal trial began.

Both doctors have pleaded not guilty to a slew of drug-related charges. The most serious allegations are that oxycodone prescriptions they wrote at "pill mill" clinics in Palm Beach and Broward counties resulted in nine deaths — seven blamed on Cadet and two on Castronuovo.

"This is about doctors who became dope dealers," prosecutor Paul Schwartz told jurors in opening statements Friday in federal court in West Palm Beach. The trial is expected to take two months.

Attorneys Michael D. Weinstein and Thomas Sclafani said the doctors never violated the appropriate standard of care and the victims died because they were addicts who abused legitimately prescribed drugs. They told jurors that federal authorities have made scapegoats of the doctors because they refused to plead guilty to crimes they didn't commit.

Cadet and Castronuovo are the last two defendants fighting out of 32 people charged in 2010 after a lengthy investigation of pain clinics operated by Wellington twins Christopher and Jeffrey George in Boca Raton, West Palm Beach, Lake Worth, Fort Lauderdale and Wilton Manors.

Cadet earned the rank of major in the U.S. Air Force and is a divorced mother of two, Weinstein said. The former ER doctor took the clinic job to spend more time with her children.

"She was duped into believing the clinics were legitimate and it's cost her everything," Weinstein said.

Castronuovo had a distinguished career in internal and nuclear medicine and was a military doctor treating Vietnam War veterans in the U.S., said Sclafani. Castronuovo understood his patients' pain because he himself used oxycodone for years to treat severe nerve pain, his lawyer said, and it would take a "Grand Canyon" leap to consider him a dope dealer.

The defense plans to call medical experts, including one from Harvard University, to testify their care was appropriate, the lawyers said.

But prosecutors said the operation was a massive money-making venture owned and staffed by criminals who profited from the huge demand for pills. Drug dealers and addicts drove a thousand miles from Kentucky, Ohio, Tennessee and West Virginia to take advantage of Florida's laxer standards, they said.

The clinics were set up to look like legitimate medical practices but "in reality, they were nothing other than drug dens" and the "largest drug distribution network in South Florida," Schwartz said.

Pain pills were crushed and snorted or injected by addicts, who dubbed the substance "hillbilly heroin." Each pill sold for a dollar or two in South Florida but fetched as much as $40 on the street in Appalachia, investigators said.

Lured by word of mouth and billboard ads along the highway, addicts and unscrupulous customers — recruited by drug traffickers who bought the pills they got — formed a line of 100 or so people outside the clinics, Schwartz said.

Fights in the waiting rooms were so frequent that the owners hired security guards to try to keep the peace while "patients" openly abused drugs in the parking lots, he told the jury.

Drugs were dispensed by an unqualified woman who also worked as a bikini model, and patients were sometimes sent for tests at a mobile MRI unit that operated 24 hours a day, seven days a week in the parking lot of a strip club, court records show.

Addicts brought "clean" urine samples in with them in containers they left emptied and heaped in clinic restrooms, and patients bribed workers to get them their pills faster, according to Schwartz and fellow prosecutor Lawrence LaVecchio.

One of the clinics generated so much cash that workers stored the money in garbage cans, then brought it to the clinic owner's home because bank officials were "nervous" about the amounts of cash being deposited, prosecutors said. When agents raided the businesses and the George family homes, they found $4.7 million in safes in the attic of the the twins' mother's house.

Christopher George is expected to testify against Cadet and Castronuovo, and will tell jurors the clinics made $40 million and put more than 20 million oxycodone pills on the streets between 2008 and 2010. The twins are now 32. Christopher George is serving more than 17 years and Jeffrey George is serving more than 15 years in prison.

Authorities arrested a total of 13 doctors and 19 workers on allegations including racketeering and money-laundering conspiracy and drug-related charges linked to the clinics.

To date, 28 defendants have pleaded guilty and several of the doctors and workers will testify – handcuffed, shackled and wearing jailhouse scrubs – against Cadet and Castronuovo. The remaining two defendants died while charges were pending.

Cadet's and Castronuovo's motive was simple greed, prosecutors said. Hired as independent contractors, they were paid $75 per patient and as much as $2,000 more a week to let the clinics use their federal licenses to purchase more drugs.

Cadet spent an average of less than five minutes with each patient, according to video from one of the clinics, investigators said.

She made more than $1 million and distributed 2.4 million pills in about 18 months, prosecutors said. She used the money to buy a condo on the beach and a Mercedes, they said.

Castronuovo, who worked a couple of days a week, made about $150,000 in a short period of time and distributed 700,000 pills, prosecutors said.

Cadet, who worked mostly at American Pain in Boca Raton and Lake Worth, ranked nationally in the top nine purchasers of oxycodone in the U.S. in 2009, according to Drug Enforcement Administration records, prosecutors said.

At Executive Pain in West Palm Beach, where Castronuovo primarily worked, the physicians were ranked in the top 60 highest dispensing physicians in the nation, prosecutors alleged.

The doctors are free on bond but face up to life in prison if convicted of the top charges -- possession with intent to distribute controlled substances resulting in death.